About the Project

The Historic Hospital Admission Registers Project (HHARP) is the result of a partnership between Kingston University's Centre
for Local History Studies and various hospital archives in London and Glasgow.
It began life in 2001 as a project to create a database of late 19th
and early 20th century admissions to the Hospital for Sick Children,
whose extensive archive is still maintained and housed
within the Great Ormond Street Hospital for Children NHS Trust.
Subsequently, the project was expanded to include three other children's
hospitals: the Evelina Hospital (now part of Guy's and St Thomas's NHS
Trust), whose records are held at the London Metropolitan Archives; the
Alexandra Hospital for Children with Hip Disease (records held at the
Museum and Archive Department of St Bartholomew's and the London NHS Trust)
and the Royal Hospital for Sick Children, Glasgow, whose records are held
by the hospital. Funding for the project came principally from the Research
Resources in Medical History Programme of the Wellcome Trust, with
additional financial support from the Friends of Great Ormond Street
Hospital, the Nuffield Foundation and the History Research Unit at Kingston
University.

The Great Ormond Street database was completed and made available in 2007,
the databases for the Evelina and the Alexandra Hospital for Children with
Hip Disease were made available in early 2010, while that for Glasgow was
completed in September 2010.

The Records

The Admission Registers of all four hospitals (plus those for Great Ormond Street's convalescent home, Cromwell House) cover a period ranging from
February 1852 (when Great Ormond Street's doors first opened) through to December 31st 1914. While the Great Ormond Street records are
continuous for the whole period, the other hospital records cover shorter runs within these dates: Cromwell House, 1869 to 1910; the Evelina, 1874
-1877/1889-1902; Alexandra Hospital for Hip Disease, 1867-1895. The Glasgow database, covers 1883 to 1904. The Registers share a common core of
information, which includes the child's name, age (in years and months), sex, and (in most cases) the address. Further columns provide a diagnosis,
date of admission into the hospital and date of discharge, and the result of treatment, which is given as 'Cured', 'Relieved', Not Relieved' or 'Died'.
Additional information, common to all records, includes the name of the admitting doctor, the child's sponsor and the ward to which they were admitted.

Individual hospitals included more information in their registers. Cromwell House records, for instance, provide information on the child's history of
infantile diseases and its vaccination status. In the Evelina records can be found brief details of treatment received and post mortem results. The
Alexandra Hip Hospital records are quite different, as all the children are suffering ostensibly from the same disease. Thus the registers focus on the
nature of the hip disease suffered, and include information about the condition of child's limbs before, during and after their stay at the hospital,
describing the deformities, presence of abscesses etc. They also frequently comment on the duration of illness before admission and likely cause of the
problem. Unlike Great Ormond Street records, those at the Evelina and the Alexandra Hip Hospital have provision for recording details of the parents -
although this information was not collected as frequently as we would have liked. The Glasgow records contain information on a patient's parents, name
and occupation and religion.

Methodology

The same methodology was applied to each set of hospital records to enable meaningful comparisons between the institutions. Funding from the Wellcome
Trust (and the Special Trustees at Great Ormond Street in the case of that hospital) enabled the Registers to be microfilmed and digital photocopies
made. The photocopies were divided into batches of approximately twenty pages, or four hundred entries, and each batch was tagged and numbered.

The databases were built in Microsoft Access, using a template originally designed for the Great Ormond Street records by Peter Tilley (the project's
technical advisor), and later adapted by Juliet Warren to incorporate new data elements from subsequent hospitals. Batches were issued to volunteers,
who input the data using a data entry programme. Initially, although most volunteers had experience of the Victorian hand, very few had medical
knowledge or were familiar with the streets of Victorian London. Crib
sheets of common disease terms, terms used in post mortem reports and
19th century therapeutics were provided, and in addition,
photocopies from the index to a 1909 London Gazetteer were
supplied to help with identifying streets or areas. The A to Z Trust
also kindly supplied a copy of the very first London A to Z
for reference. The same team of volunteers has worked on the project
throughout, and as they gained experience their ability to transcribe
the specialised content accurately grew, such that by 2010 they
represent a very skilled group of workers.

In order to maintain the integrity of the Registers, entries were typed into the database exactly as they appeared, even where it was suspected that a
mistake had been made by the clerks. Standardised versions of the key data elements enabled such original errors to be corrected while maintaining the
integrity of the source material. A rigorous system of proofreading ensured every entry was checked twice, to minimise the introduction of 21 st century-typographical errors, and the process was completed by a series of computerised validations.

Addresses

In order to help users locate addresses, additional fields were added to the database to provide standardised spellings of street names, and for
London-based addresses Registration Districts and Registration sub-districts have been added. For addresses outside London, it is planned to add a
county name, and this enhancement will be available in the next release of the website. This complicated and painstaking work was undertaken at
Kingston by Juliet Warren. A similar approach has been taken with the Glasgow addresses - with the help of local volunteers from the Glasgow and West
of Scotland Family History Society.

The Diseases

Children's diseases in the nineteenth century were imperfectly understood, and nosology has changed greatly since then. Diseases range from the
expected typhoid fever and (w)hooping cough to talipes (club foot) and taenia (tapeworm). Many children were admitted with diseases of poverty, such as
tubercular joints and lungs, rickets and rheumatism. Abscesses, caused by infections, under-nourishment and tubercular conditions, were common, and
eczema was remarkably prevalent. Chorea, or St. Vitus' Dance, is now familiar to all involved in the project, as is the distressing strumous
ophthalmia, an eye condition rampant in children's homes and orphanages. As with the addresses, volunteers entered the disease or condition exactly as
it was written in the Register. This resulted in many different spellings of even common diseases such as diarrhoea and scarlet fever. A new field was
added to the database containing a standardised spelling of the diagnosis and two levels of classification were applied. The first, developed
specifically for the project by Dr Andrea Tanner and Dr Sue Hawkins, groups diseases by body site, and the second applies the modern World Health
Organisation's International Classification of Diseases (ICD10) to the condition, work which was undertaken by Alicja Skowronska, a senior medical
coder at Great Ormond Street Hospital for Children.

The Case Notes

Fourteen volumes of case notes for Great Ormond Street's Dr Charles West survive, and they have been made available via the database. Each page was
scanned, loaded in the website and linked to the relevant patient's entry in the main database.

HHARP Website

The HHARP website has evolved from our original website Small and Special through which the Great
Ormond Street database was made available to a world wide audience, free of charge. Now we are adding two more hospitals, with a third scheduled for
later this year, it was no longer appropriate for the website to be so closely
associated with one institution, and HHARP was
conceived as a portal into the world of Victorian and Edwardian children's
hospitals. Although it has a new look (and two additional databases)
HHARP maintains the underlying structure of the
original site. Its much praised easy-to-use search facility has also been
retained. Access remains unrestricted and the new website is completely
free to all users. Restrictions applying to volume downloads have been
maintained, to protect the database from unscrupulous users.

The original library of articles in Small and Special, on topics relating to the Great Ormond Street Hospital including its history,
pen-portraits of some of the medical officers, nurses and patients, have been retained in HHARP. In the new website,
the library will be enhanced by the addition of articles on the history of
the Evelina, the Alexandra Hip Hospital and Royal Hospital for Sick
Children, Glasgow, their staff and patients. The articles have been
contributed by the team's medical historians, Dr Andrea Tanner and Dr Sue
Hawkins, hospital archivists and others involved in the Project.

The gallery of images portraying the hospitals and their inhabitants in the
period will be similarly enhanced, moving images under the individual
hospital sections and also providing images of the original registers.

A new section has been added to Historical Background, 'General', where
articles contributed by leading historians on health provision and issues
of the late 19th century will be discussed.

Project Team

Dr Andrea Tanner - Project Director

Dr Christopher French - Director of the Centre for Local History Studies, Kingston University (now retired)

Dr John Stewart - Director of the centre for Local History Studies, Kingston University (current)

Juliet Warren - Researcher and Database Manager, Kingston University

Annie Sullivan - Volunteer Manager, Kingston University

Dr Sue Hawkins - Project Manager and Researcher, Kingston University

Nicholas Baldwin - Archivist, Great Ormond Street Hospital for Children

Technical Consultants

The Project team would like to acknowledge the enormous contribution made by the large number of dedicated volunteers and Kingston University students,
without whose work on transcribing the registers, checking and correcting the database, this project would have been impossible.

We are also indebted to Anne Morgan (Amendit Design Services) who designed both the original site and its new incarnation in HHARP and who sadly died in late 2009.

Dr Elizabeth Lomax

The Project team was extremely grateful to Dr Elizabeth Lomax for allowing us to borrow Small and Special as the name for the original
website; and hope she will forgive us for the move to a new name. Her book,
Small and Special: the development of hospitals for children in Victorian
Britain, remains an inspiration to our work on children's hospitals.